Much of the spotlight for coronavirus disease 2019 (COVID-19) is on the acute symptoms and recovery. However, many recovered patients face persistent physical, cognitive, and psychological symptoms well past the acute phase. Of these symptoms, fatigue is one of the most persistent and debilitating. In this “perspective article,” we define fatigue as the decrease in physical and/or mental performance that results from changes in central, psychological, and/or peripheral factors due to the COVID-19 disease and propose a model to explain potential factors contributing to post-COVID-19 fatigue. According to our model, fatigue is dependent on conditional and physiological factors. Conditional dependency comprises the task, environment, and physical and mental capacity of individuals, while physiological factors include central, psychological, and peripheral aspects. This model provides a framework for clinicians and researchers. However, future research is needed to validate our proposed model and elucidate all mechanisms of fatigue due to COVID-19.

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The primary purpose of this study was to determine the influence of load compliance on time to failure during sustained isometric contractions performed with the elbow flexor muscles at four submaximal target forces. Subjects pulled against a rigid restraint during the force task and maintained a constant elbow angle, while supporting an equivalent inertial load during the position task. Each task was sustained for as long as possible. Twenty-one healthy adults (23 ± 6 yr; 11 men) participated in the study. The maximal voluntary contraction (MVC) force was similar (P = 0.95) before the subjects performed the force and position tasks at each of the four target forces: 20, 30, 45, and 60% of MVC force. The time to task failure was longer for the force tasks (576 ± 80 and 325 ± 70 s) than for the position tasks (299 ± 77 and 168 ± 35 s) at target forces of 20 and 30% (P < 0.001), but was similar for the force tasks (178 ± 35 and 86 ± 14 s) and the position tasks (132 ± 29 and 87 ± 14 s) at target forces of 45 and 60% (P > 0.19). The briefer times to failure for the position task at the lower forces were accompanied by greater rates of increase in elbow flexor muscle activity, mean arterial pressure, heart rate, and rating of perceived exertion. There was no difference in the estimates of external mechanical work at any target force. The dominant mechanisms limiting time to failure of sustained isometric contractions with the elbow flexor muscles appear to change at target forces between 30 and 45% MVC, with load compliance being a significant factor at lower forces only.

To identify the underlying physiological mechanisms for the difference in the time to failure for two types of fatiguing contractions, 20 subjects performed force and position tasks with the elbow flexor muscles at a comparable net muscle torque for a similar duration. Prior to terminating each task, blood flow was occluded to estimate the relative amount of feedback transmitted by small-diameter afferents to the spinal cord. Mean arterial pressure at the conclusion of the fatiguing contraction increased similarly for the two tasks (force: 119% +/- 14%; position: 114% +/- 15%). However, the final values for the electromyographic activity for the elbow flexor muscles (26% +/- 14% and 21% +/- 11%, respectively; P < 0.05), and the increase in the fluctuations in acceleration and force (225% +/- 152% and 154% +/- 53%, respectively; P < 0.05) in the sagittal plane, were significantly greater during the position task compared with the force task. These results suggest a different balance in the excitatory and inhibitory inputs to the spinal motor neurons for the two tasks, which has implications for the design of work tasks and exercise prescription in rehabilitation.